The utility of a medical admissions pharmacist in a hospital in Australia

Abstract

Background Medication-related hospital admissions in Australia have previously been estimated to account for approximately 3% of all hospital admissions, with hospital entry points being a point of vulnerability. The timely medication review and reconciliation by a pharmacist at the early stage of an admission for patients admitted to the Acute Medical Unit (AMU) would be beneficial. Setting The Emergency Department (ED) and AMU in a 300 bed tertiary teaching hospital, in South Australia. Objective To investigate the impact of a Medical Admissions (MA) pharmacist on the proportion of AMU patients who receive a complete and accurate medication history by a pharmacist prior to admission and within 4 h of presentation. Method This prospective observational study with a non-concurrent parallel study design examined a standard clinical pharmacist service within the AMU and ED to a Medical Admissions (MA) Pharmacist, in addition to the standard AMU and ED pharmacist service. Continuous variables were analysed using a two sample t test, whilst categorical data were analysed using Fisher’s exact test. Risk ratios were also calculated for categorical data, with p < 0.05 taken as statistically significant. Main outcome measures Rates of completion of a complete medication history prior to admission and proportion of patients seen within 4 h of presentation by a pharmacist. Results The intervention resulted in more patients receiving a complete medication history prior to admission (2.7% in the control group vs 18.5%, p < 0.01) and being seen by the pharmacist within 4 h of presentation (1.6% in the control group vs 7.5%, p < 0.01). Conclusion Implementation of an extended hours clinical pharmacy service in the form of a medical admissions pharmacist based in the ED significantly increased the number of complete medication histories and clinical reviews completed for patients being admitted to an AMU. These were also completed earlier in the patients’ admission. There was also a small trend toward increasing the proportion of patients discharged by 11 am in the intervention group.

Notes

Acknowledgements

The Queen Elizabeth Hospital Pharmacy Department and clinical pharmacy team contributed to the implementation, and ongoing data collection for this project. Statistical support was provided by Sheridan Gentili from the University of South Australia. Anne-Marie Young, Casemix Manager, and Elizabeth Harnack, Emergency Medicine Administrator at The Queen Elizabeth Hospital assisted with data collection.

Funding

Funding for this project was provided by SA health as part of the Improving Care program.

Proper JS, Wong A, Plath AE, Grant KA, Just DW, Dulhunty JM, et al. Impact of clinical pharmacists in the emergency department of an Australian public hospital: a before and after study. Emerg Med Australas. 2015;27(3):232–8.CrossRefPubMedGoogle Scholar